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The new hyperacute stroke centres will improve care and there will
have to be radical new changes in working practices.[1] There are only two
options for delivering expert 24/7 face to face care: option one is to
have the consultant stroke expert on site in the hyperacute unit and
option two is to have the consultant off site but with audiovisual input
to the hyperacute unit via telemedicine. A telemedicine model was not
considered for Londoners because according to Healthcare for London
documents “clinical advisers recommend that face to face timely care from
a clinical expert represents best practice.” The medical staff and skills
for the 8 HASUs are reported as “each HASU needs to be supported by at
least six consultants working to provide 24/7 cover as well as full on-
site team including stroke experienced middle grade doctors.” These stroke
experienced middle grade doctors on site are not clinical experts and will
not be delivering the best expert practice face to face as was sold to the
public in the consultation.
St Thomas’ Hospital has developed expertise in the area of
telemedicine. It would be useful to use such expertise to ensure the best
use of expert consultant time and reduce costs by developing an out of
hours telemedicine support service for the 8 HASUs. Having 8 consultants
doing night shifts makes no clinical or financial sense. This use of
telemedicine would deliver the face to face expert care that is said to be
a reason for having chosen the 8 HASU model.
It would also be useful to take a further look at a thrombolysis and
telemedicine option as a recent review by stroke expert Professor Gary
Ford and colleagues shows that telemedicine with secondary transfer ("drip
and ship") delivers a higher rate of thrombolysis (6.9 per 100 confirmed
stroke patients) than emergency service redirection of all suspected
stroke patients to a stroke centre (3.8 per 100).[2]
[1] Mashta O. London is to get 12 new specialist stroke and trauma
centres. BMJ 2009;339:b2983
[2] Price CI, Clement F, Gray J, Donaldson C, Ford GA, Systematic
review of stroke thrombolysis service configuration. Expert Review of
Neurotherapeutics 2009 ;9(2):211 - 233
Telemedicine or eight expert stroke consultants working night shifts: which option will be used in London to deliver the best practice face to face stroke care 24/7 in hyperacute units?
The new hyperacute stroke centres will improve care and there will
have to be radical new changes in working practices.[1] There are only two
options for delivering expert 24/7 face to face care: option one is to
have the consultant stroke expert on site in the hyperacute unit and
option two is to have the consultant off site but with audiovisual input
to the hyperacute unit via telemedicine. A telemedicine model was not
considered for Londoners because according to Healthcare for London
documents “clinical advisers recommend that face to face timely care from
a clinical expert represents best practice.” The medical staff and skills
for the 8 HASUs are reported as “each HASU needs to be supported by at
least six consultants working to provide 24/7 cover as well as full on-
site team including stroke experienced middle grade doctors.” These stroke
experienced middle grade doctors on site are not clinical experts and will
not be delivering the best expert practice face to face as was sold to the
public in the consultation.
St Thomas’ Hospital has developed expertise in the area of
telemedicine. It would be useful to use such expertise to ensure the best
use of expert consultant time and reduce costs by developing an out of
hours telemedicine support service for the 8 HASUs. Having 8 consultants
doing night shifts makes no clinical or financial sense. This use of
telemedicine would deliver the face to face expert care that is said to be
a reason for having chosen the 8 HASU model.
It would also be useful to take a further look at a thrombolysis and
telemedicine option as a recent review by stroke expert Professor Gary
Ford and colleagues shows that telemedicine with secondary transfer ("drip
and ship") delivers a higher rate of thrombolysis (6.9 per 100 confirmed
stroke patients) than emergency service redirection of all suspected
stroke patients to a stroke centre (3.8 per 100).[2]
[1] Mashta O. London is to get 12 new specialist stroke and trauma
centres. BMJ 2009;339:b2983
[2] Price CI, Clement F, Gray J, Donaldson C, Ford GA, Systematic
review of stroke thrombolysis service configuration. Expert Review of
Neurotherapeutics 2009 ;9(2):211 - 233
Competing interests:
None declared
Competing interests: No competing interests